Friday, November 1, 2013


What is severe RSV disease?

Respiratory syncytial virus (sin-SISH-shul VI-rus), or RSV, is a common, seasonal, and easily spread virus. In fact, nearly all children will get their first RSV infection by age 2.  
Like most viruses it ranges in it's severity from case to case.
Severe RSV disease is the number one reason babies under 12 months old have to be admitted to hospitals in the US.
You know the wretched colds that knock you flat and stand out in  your memory? These are the colds that come with runny noses, sniffling and sneezing, harsh cough and fever. That illness might well be RSV.
I actually can almost diagnose it over the phone when I hear the patients coughing. The cough sounds like it hurts.

There is a test that we can do in the office (a swab to the nose) to see if it is RSV or not, but unless your child is looking really sick we might not bother. It doesn't necessarily change the approach.
We often do nebulizer treatments for our wheezers, but with RSV they don't always help all that much.

Time usually fixes this and all that we can offer is often the same symptomatic treatment  and supportive care that we would do for any bad cold and cough
Treat the fever as needed
Clear the mucous with saline/ breast milk and a Nose Frida/ aspirator
Keep the heads elevated
Do doses of steamy bathrooms and use a humidifier at night.
Increase fluids during the day.

RSV can cause ear infections and pneumonia

Severe RSV disease symptoms include:

  • Coughing or wheezing that does not stop
  • Fast or troubled breathing
  • A bluish color around the mouth or fingernails
  • Spread-out nostrils and/or a caved-in chest when trying to breathe
  • Gasping for breath

If your child is having trouble breathing, or significant trouble feeding, they may need to be hospitalized for a night or two for fluids, oxygen and observation.
I would say that we have several kids routinely hospitalized for this every year. (not just young babies)
There is no other real treatment for RSV other that close observation, but for certain high risk patients, there is a medication that is given monthly that significantly protects them.
This medication is called Synagis.
If your child was premature (earlier than 35 weeks gestation), has cardiac or pulmonary issues they may qualify. Talk to your doctors office ASAP to find out if your child fits into the guidelines. Alas the guidelines are quite restrictive. This season I will be giving the synagis to only 4 of our patients.
The medication is given monthly during the RSV season for a total of 5 doses.
In California the official RSV season starts on November 1st
(I don't think that RSV knows that it has a season...but that is when the almighty insurance companies will start shipping the medication)

Since most of our children can not get protected with synagis, please take precautions to prevent the spread of this nasty virus, especially for the youngest most vulnerable babies.

  • Wash your hands before touching your child. Make sure others wash up, too
  • Clean toys, crib rails, and any other surfaces your baby might touch
  • Try to keep your baby away from crowds. Avoid anyone with a cold or fever
  • Don't let anyone smoke near your baby. Tobacco smoke can increase the risk of severe RSV disease

Sadly it takes multiple exposures before you develop immunity. Most folks get it about 8 times until they finally seem to be safe!
It spikes again in older folks when the immunity tends to wane and it can sweep through retirement communities, so be cautious for the older adults in your life as well.

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